Who decides what hip surgery an elderly patient with no kids or power of atty should have if she can’t?

Question by LaCasa Studio: Who decides what hip surgery an elderly patient with no kids or power of atty should have if she can’t?
A question in my medical class. A 85 year old woman who is cheery and alert needs hip surgery due to falling in the nursing home. Her meds have her to groggy to make a decision and the dr knows she has no family or power of atty but needs to make a decision soon. He has a choice of two surgeries. Who should make the decision of which surgery she should have?

Best answer:

Answer by A TBack off the meds a bit and let the patient decide (assuming she’s been worked up by ortho and they’ve decided she’s a surgical candidate, which seems to be the case since you state there are two surgical options). If the patient is too sedated (I’m assuming from narcotic analgesics?) to provide consent then you may well be dosing a bit too aggressively… If it NEEDS to be soon, bust out the naloxone…

Side note, if she’s “cheery and alert” then she cannot be “too groggy to make a decision soon.”

Edit: If your class is looking to find out who has responsibility for medical decisions in a patient unable to provide consent, that’s a matter that’s out of my scope of practice (I’m the wrong kind of doctor…). If you can use the workaround to teach your prof to write better questions, well in that case…

Edit #2: Unless your professor is getting at the point that medications (narcotics anyway) cannot be used to render a patient unable to consent to circumvent their right to participate in the medical decision-making process…. Oh, the possibilities!

Edit #3: Thanks for the backup grimmyTea, not an area I’ve had any formal training in.

One thought on “Who decides what hip surgery an elderly patient with no kids or power of atty should have if she can’t?”

The pharmacist is exactly right. If meds are the cause of her incompetency, then simply stop medicating her. I would be hesitant though about giving naloxone to an 85-year old, unless absolutely necessary. I would prefer to just wait for the meds to wear off. It would be unusual to have a hip surgery that needed to be done right away. Certainly, the longer you wait, the more problems you will have with muscles around the broken hip shortening; but a few hours shouldn’t make much of a difference.

If the patient is not going to recover competency (maybe she has dementia–as pharmacist noted, how can she be cheery and alert, yet too groggy to make a decision?), then you are talking purely about decision-making chain. In the absence of family or a power of attorney, then the hospital would probably seek to have the state (or the hospital itself) take over guardianship of the patient (although this probably varies from hospital to hospital, or state to state). In an urgent or emergent medical situation, then you wouldn’t have time for this. At my hospital, in emergent situations, the surgeon would make the decision. In an urgent situation, we would proceed with surgery if two physicians agreed it was in the patient’s best interest. The choice of surgery would probably be deferred to the surgeon.